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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

NEPAL REPORT: Kathmandu's Challenge

Nepal's leprosy program must reach the country's difficult-to-reach populations.

In the WHO-South East Asia Region, Nepal is one of two countries yet to achieve the goal of eliminating leprosy as a public health problem, the other being Timor Leste.

Annual numbers of new leprosy cases have decreased dramatically since the commencement of multidrug therapy (MDT) in 1982/83, when there were 31,527 cases on treatment. However, at the end of the Nepali calendar year 2007/2008 in June, there were 3,817 cases on treatment, making for a national prevalence rate (PR) of 1.42 per 10,000 population. The trends in PR and in the new case detection rate (NCDR) over five years show steady but slow decline, not sufficient for Nepal to have reached the elimination goal by now.

Administratively, Nepal is divided into five developmental regions. However, there are three topographically distinct regions in the country: the Mountain region (35% of the land mass), the Hilly region (42%) and the Plains or Terai region (23%). Nearly half (48.4%) of the country's population lives in the Terai region, wherein 82% of new cases were detected during 2004/2005.

At the district level, there are 42 districts with a PR of below 1 per 10,000 population and 14 where the PR is above 2, most of them in the Terai region. Detailed analysis of district-level data for the Nepali calendar year just ended will soon be available.

SIMPlIFIED APPROACH

In recent years, due to security reasons, the movement of health personnel was restricted in a number of districts in the Terai region. To address this challenge, the national program in October 2007 conducted an informal program review meeting in collaboration with partners, and agreed upon a simplified strategic approach to intensify activities in one of the highly endemic districts through the active involvement of local health staff and the community.

The national program was able to review the cases on treatment and update the registry for treatment completion at the health center and district levels. As a result, the registered prevalence in the area was reported to have gone down.

With recent political developments and improved mobility of health personnel, the national program has decided to replicate the approach in six more hyper-endemic districts. This will be done in collaboration with the WHO Nepal Country Office with a view to reaching the difficult-to-reach populations of the remote communities.

The WHO Representative to Nepal has indicated that three teams will be formed, each responsible for two districts. The local health staff and the community will work together, after a brief training stint, in reviewing the cases on treatment and updating the registry for treatment completion at the health center and the district levels. The WHO country representative invited the Global Leprosy Program and the South-East Asia Region staff to accompany the local health team to the areas and provide direct technical support as and when necessary. Gradually, the national program, in collaboration with the WHO and other partners, expects to expand the approach to other parts of the country with a view to reaching elimination. Nepal is exerting concerted effort to achieve the elimination target, in spite of the existing situation.